Jason Tetro, author of The Germ Code: “Moving forward, I think we’re going to be going into this idea of seasonality, or as I like to say, cold, flu and COVID-19 seasons.” And the so-called "monster variant"? It's already here, says Tetro. It's called Delta.
Think about measles, says Jason Tetro, author of The Germ Code and The Germ Files, and host of the popular podcast The Super Awesome Science Show. “Have you ever actually seen cases of it in the last 20 years here in North America?” Tetro asks rhetorically in an interview with Infection Control Today®. The answer is no, or maybe some sporadic small outbreaks here and there. That’s where COVID-19 is heading, says Tetro. It will burn itself out. The United States might have to deal with waves of COVID-19 in the next six months or so. However, viruses are like wildfires, says Tetro. When the fuel runs out, the wildfire dies. The fuel will run out with COVID-19 through some combination of vaccination and prior infection. He tellls infection preventionists (IPs) charged with having to convince hesitant colleagues to get the COVID-19 vaccine, to rely on the science, which is solidly on the IPs’ side. If that doesn’t work, bring it down to a level that anybody can understand. Won’t it be nice to return to a life where we can again hug loved ones without fear?
Infection Control Today®: So, where do we go from here, Jason?
Jason Tetro: Well, we’re now at the point where we’ve essentially gone through about 20 months of learning and figuring things out, since we first heard about this atypical pneumonia that was being seen in China. And I think we’re at a point now where we have the ability to move away from this idea of a pandemic, and into something that looks a little bit more like seasonality. And that’s where we start getting into this idea of waves. And the reason I say that is because in order for us to get away from pandemic and endemic, we need to have a fairly large amount of immunity in the population. It’s about 85%. Really, and at this point, we haven’t quite gotten there yet. But we’re getting closer. And when I talk about immunity, I’m not only talking about vaccination, because that is obviously the best approach. But I’m also talking about those who have been infected. But I do want to point out one thing. The chance for reinfection is somewhere around 2 to 9 times higher than it would be for an infection that’s called a breakthrough. In other words, you’ve been fully vaccinated, but you still come down with an infection. So that’s where we are today. Moving forward, I think we’re going to be going into this idea of seasonality, or as I like to say, cold, flu and COVID-19 seasons.
ICT®: I’m sorry, I didn’t quite understand the math there: two to nine times greater chance if you’re not vaccinated for…?.
Tetro: If you are not vaccinated, you are countless amount of times more likely to become infected. If you have had a prior infection, you’re two to nine times more likely to be reinfected depending on which strain or lineage infected you in the first place. Let’s just put it this way. If you were infected with the original lineage, the one that was seen in December of 2019, then you have a nine times greater chance at becoming reinfected with Delta than if you were vaccinated. If you were infected with Delta, then you have a 1.75 times chance of being reinfected with Delta than if you were vaccinated.
ICT®: You’re a Canadian citizen. How’s Canada doing as far as vaccination rates?
Tetro: We’re doing really well. We’re getting closer and closer to that landmark of 85% fully vaccinated. We do run into the same problems as we see in America and other countries. We have about a 15% to 20% of the population who—isn’t necessarily hesitant—but simply are opposed to the idea of vaccination in general. And they’re causing a bit of a problem because we’re right at the crux. Like if we needed 90% instead of 85%, we probably would never get there because of these individuals. What we are doing right now is we’re trying to make sure that we improve the vaccination rate by getting those who are not really sure. You know, they want more information or something or maybe they have heard a lot of misinformation and they’re just, you know, not entirely convinced [about getting] the vaccine. Through basically not enforcement, but restrictive measures. And by that I mean the vaccine passports even though they’re not called that in every one of the Canadian provinces.
ICT®: Let’s take on the subject of vaccine hesitancy among health care professionals. Infection preventionists have their feet on the ground, trying to educate their fellow health care professionals about the benefits of getting vaccinated. What advice do you have as far as going about that? That must be a bit of delicate dance, correct?
Tetro: There are usually several different points that people bring up when it comes to vaccinations. The first one is that it’s brand new. That it’s never been tested before. And that’s not really true. It’s been around for about 40 years. This particular concept for the technology: It’s been in the science wet benches for 30 years. But more importantly, the actual technology has been approved by the FDA [Food and Drug Administration] in a drug called onpattro. So, in that sense, we really don’t have to say it’s never been tested, or that it’s new. It really isn’t. It’s
kind of like the overnight success in movies where they’ve been acting since they were 3 years old, but they become an overnight success at 40. That’s basically what we're dealing with. The second thing that people then come up with is that we’re dealing with a vaccine that could possibly cause problems within the body. And I mean, you understand that, because we have seen this type of concern with other vaccines in the past. So, it’s just being repeated. But what’s very interesting is that when you’re talking about mRNA vaccines in particular, they don’t have the same type of approach in the cell that we see with an attenuated whole virus, whatever it may be. [The COVID-19 vaccine] is just basically a piece of genetic material that is going in to yourself asking for permission to produce the spike protein, and then the spike protein is put on the top of the cell so your immune system can recognize it and gain a memory. And that’s all that it is. And then of course, the third one that comes after that is, “Well, it’s mRNA. Isn’t that gene therapy?” And the answer is no. And that comes down to grade nine biology. If you remember, you have a cell, and inside the cell, there is a nucleus, and inside the nucleus, there’s your DNA. That’s it. mRNA is not in the nucleus. When the mRNA comes into the cell, it’s on the outside, it’s not in the nucleus. Gene therapy, by definition, requires you to do something with the DNA inside the nucleus. Therefore, it is not gene therapy. It’s just a little piece of genetic material that is coming in. And it’s usually destroyed within two to three days after it’s gone into the cell. When you get to that point, you’ve taken away a lot of the so-called scientific arguments that they may have. And then you start getting into the policy and possibly even the political ones. And that’s where it starts to get a little bit trickier. But in terms of the science, infection preventionists can always rely on what we already know, and have known for many, many, many years, [and be able to teach them that].
ICT®: Do you notice that there might be a divide among health care professions in hospitals between white-collar and blue-collar workers? You have the doctors and nurses. And then you have environmental services, the kitchen crew, the maintenance department, building department. Is there a divide along those lines?
Tetro: The majority of divides that I’ve seen and, again, I’m in Canada—but we do see this as well in health care workers—is usually political. And in that sense, what they are more concerned about are the mandates. They don’t want to be forced to take the vaccine. They may actually still get the vaccine. But because they seem like they’re being forced to do it, they’re going to be hesitant. We’ve also seen what is known as religious exemptions, and in those particular cases, at least here in Canada, they’ve been tested at the legal level, and they have never actually succeeded. Religious exemptions simply do not apply. In terms of getting past that polarization that comes from the political maneuvering of liberty versus mandates. I think one of the things people have to understand is that when we talk about vaccination, it doesn’t matter what education level you may have. Basically, it’s just something that is designed to help protect you against an infection that could possibly take away your life. When we start looking at how we can provide messaging to these individuals, one thing that I learned from Ebola with the World Health Organization was to make sure that you’re incorporating stories. And I don’t know if you’ve seen or not, but over the last two to three months, we’ve been hearing stories about individuals who were hesitant about vaccines or simply were against vaccines, who have unfortunately ended up in the ICU. And in the worst-case scenarios passed away. And those stories have actually been used to highlight the true dangers of the virus itself. What we now need to be able to do is to sort of move that and shift that a little bit so that we’re talking to people who have been vaccinated, and what that has meant to the resumption of their normal lives. The resumption of their ability to see people. The resumption of being able to hug someone. And that’s really one of the things that we need to be able to do so that we’re no longer talking at the high level of science that you, myself, and infection preventionists all speak. We’re talking at the human level.
ICT®: As you know, most of the world has not been vaccinated. The last numbers I saw say that fewer than 50% of the world’s population have received at least one dose. And in poorer countries, it’s something like 2%. Can we ever get beyond this pandemic if tmost of the people in the world aren’t vaccinated?
Tetro:Let me put it to you like this. Are you familiar with measles?
Tetro: Have you ever actually seen cases of it in the last 20 years here in North America? Just maybe that Disneyland case, and maybe that fair in Indiana, right? [Outbreaks of measles are] very small and sporadic. What people may not know, though, is in the country of Madagascar, back in 2018, they had over 100,000 cases, and they had many deaths from measles. But we all thought measles was over. Because we all have access to a vaccine. They do not. The idea is that as much as we want to have vaccine equity—VE, as some people are calling it—we are going to always find ourselves in a situation where low- and middle-income countries are going to lag behind us. We have COVAX. We have other programs that are going to help to bring vaccines to these other countries. And hopefully, we will be able to bring up the level of vaccination, even if it’s only one dose to over 70% across the world. But that may not happen for at least another year or so. And in that light, we’re now talking about giving third doses to people who have weakened immune systems. And after the case of Colin Powell, we can see why that is so important. There are always going to be barriers to being able to get certain populations the vaccine. I think we’re doing better now than we have in the past. But in order for us to get to the level that we’ve seen with something like polio, we do need to start thinking about how we can not only just ramp up production, but also slow down the absolute hunger and dependence on it in First World and high-income countries
ICT®: Two issues. The efficacy of the vaccines. Are they effective enough? The other one is the so-called monster variant that would push Delta out of the way and be able to avoid antibodies, whether they were produced by prior infection or vaccines. What about that?
Tetro: Let’s just tackle the second one first. What’s the monster variant? It’s here. It’s called Delta. Because what had happened is that this particular variant gained the ability to multiply in your body like the common cold. And when that happened, it had the ability to overwhelm immune systems, even if they had been vaccinated. And that’s one of the reasons why the third booster is so necessary because it provides you with the ability to create enough antibodies to tackle the Delta variant. That is our monster variant. We have seen other variants come out since Delta has taken over. They’re not doing anything. There’s even something called Delta plus that really isn’t doing much. In that light, I think we might be at the worst when it comes to what COVID-19 can offer. Now, is there the potential for us to have a variant that is going to be completely resistant against all the different types of antibodies and T cell responses that have been developed, whether it be through previous infection or vaccines? No, because cross reactivity happens all the time. It’s one of the reasons why, even though we recommend flu shots every year, even if you don’t get it, there’s a very good likelihood you’re not going to have a massive serious infection if you come down with the flu. The only time that changes is when you have a flu that has changed so much that you may only have a very low efficacy against it. We’re not seeing that with SARS-CoV-2. That’s another difference between the two viruses. Then we go to vaccine effectiveness, and I’ve got to tell you something. You can actually split the pandemic into two different timelines: BD, before Delta, and PT, post Delta, or we’re currently in that, but you know what I mean. And the reason that is a problem is because when it was before Delta with the original linage, Alpha, Beta, Gamma, we only needed 40% of the population fully vaccinated in order for us to eliminate it. Now, we need 85%. And it’s not because of the effectiveness of the vaccine. It is simply the fact that Delta can overwhelm the immune response. When we talk about how effective a vaccine is we need to break that down a little bit more into: Is it stopping the virus? Or is it promoting enough immune response to be able to tackle the virus? When it was before Delta? It was all about the first question. And the answer was yes. When it comes to the second question, it’s only 85% there. One of the things that you need to realize is that if you are at that 85%, in order for us to achieve that herd immunity through vaccination, we have to get up around 88% to 90%. Hopefully, we can still start decreasing the amount of virus that’s being spread with lower levels of vaccination, maybe 75% to 80%. But again, in order for us to be truly and fully confident that vaccination is going to get rid of this virus so that we’re not dealing with waves, we need to be at 90%, which takes us back to the very beginning, which is, yeah, we’re going to have to deal with waves.
ICT®: Is there something that I neglected to ask you that you think you’d like health care professionals to know about?
Tetro: Right now, the big problem that we’re facing is the unvaccinated. We’re hearing it being called the pandemic of the unvaccinated. And are we going to have to live this way because of the unvaccinated? And the answer is no. What we’ve learned over the last 20 months is that not vaccinating will cause problems. But what we’ve also known is that viruses, and pretty much any kind of infectious disease, will be just like wildfires. When you run out of fuel, the wildfire essentially ebbs away and disappears. There’s a lot of fuel that’s currently out there. A mix of restrictions and vaccinations is going to make sure that we can live a fairly normal life and in many places around the world, that’s what’s going on. But in order for us to be able to be sure that we are getting to a measles level, when it comes to this virus, we do need to make sure that the fuel is gone. And the best way to do that is through vaccination. But infection with Delta is also going to get us there. I would much rather we don’t see infections because that ends up causing downstream effects on our hospitals, on our ICUs. But at the end of the day, regardless of how you see it, it is going to end. Whether it ends at the beginning of 2022, because we’ll have the child vaccines approved and it will be able to get us close to 85% fully vaccinated, or whether it’s Christmas of next year, where the fuel simply has gone out. That’s what we’re looking for. In the meantime, we just need to keep focusing on doing everything that we possibly can to inform our friends, our loved ones, and those around us on the best approaches to be able to stay safe, whether it be vaccination, or as I said, right from the very first time we started talking about COVID-19, the ABCs: protecting your airway, sticking to your bubbles, and always knowing who your contacts are. That basically is how we need to live at least for the next six months, probably at the most 18 months.
This interview has been edited for clarity and length.